Hattori Aritoshi, Takamochi Kazuya, Kitamura Yoshitaka, Matsunaga Takeshi, Suzuki Kazuhiro, Oh Shiaki, Suzuki Kenji
Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan.
Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan.
Gen Thorac Cardiovasc Surg. 2019 Feb;67(2):247-253. doi: 10.1007/s11748-018-1017-8. Epub 2018 Sep 24.
We aimed to analyze the risk factors of postoperative cerebral infarction (CI) and thrombus formation in the left upper pulmonary vein (PV) stump after lobectomy.
We retrospectively investigated 1670 patients who underwent lobectomy or more intervention, and analyzed the risk factors of postoperative CI. Furthermore, postoperative contrast-enhanced computed tomography (CE-CT) were reviewed in patients who underwent left upper lobectomy (LUL), and risk factors of the thrombus formation in the left upper PV stump were evaluated. Chi-square test or unpaired t test was used to compare the factors.
Cerebral infarction was observed in 10 (0.60%) patients, being more significant in patients with left side lesions (90%) who underwent LUL (50%). Eighty percent of the CI cases occurred by day 4 postoperative. CI was found in 1.47% after LUL. Among 339 patients who underwent LUL, CE-CT was performed in 137 (40%) postoperatively. Among them, left upper PV stump thrombus was found in 16 (11.7%), which was statistically significant in higher age and p stage II or more disease (= 0.003, 0.040). In contrast, preoperative histories including anticoagulant administration, atrial fibrillation, diabetes mellitus, several surgical procedures or intraoperative factors were not associated statistically with thrombus formation.
Postoperative CI occurred in the very early-phase after lobectomy, and the incidence was significantly higher in patients undergoing LUL. Because left upper PV stump thrombus was frequently found retrospectively, a prospective observation study would be required to investigate the real incidence of PV stump thrombus after lobectomy.
我们旨在分析肺叶切除术后脑梗死（CI）及左上肺静脉（PV）残端血栓形成的危险因素。
我们回顾性研究了1670例行肺叶切除或更多干预措施的患者，并分析术后CI的危险因素。此外，对接受左上叶切除（LUL）的患者的术后增强计算机断层扫描（CE-CT）进行了回顾，并评估了左上PV残端血栓形成的危险因素。采用卡方检验或非配对t检验比较各因素。
10例（0.60%）患者发生脑梗死，在接受LUL的左侧病变患者（90%）中更为显著（50%）。80%的CI病例发生在术后第4天。LUL术后CI发生率为1.47%。在339例接受LUL的患者中，137例（40%）术后进行了CE-CT。其中，16例（11.7%）发现左上PV残端血栓，在年龄较大和p分期为II期或更高分期的患者中具有统计学意义（=0.003，0.040）。相比之下，包括抗凝药物使用、心房颤动、糖尿病、多次手术或术中因素在内的术前病史与血栓形成无统计学关联。
肺叶切除术后极早期发生CI，接受LUL的患者发生率显著更高。由于回顾性研究经常发现左上PV残端血栓，因此需要进行前瞻性观察研究以调查肺叶切除术后PV残端血栓的实际发生率。
